Ocular findings in patients with transfusion-dependent β-thalassemia in southern Iran

Abstract

Background Ocular involvement may occur via several mechanisms in patients with transfusion-dependent β-thalassemia (TDT) mainly chronic anemia, iron overload and iron chelator toxicity. We aimed to evaluate the frequency of abnormal ocular findings and their relationship with hematologic parameters in TDT patients. Methods In this cross-sectional study from January 2018 to January 2019, a total of 79 patients with TDT over the age of 18 who were on iron-chelation therapy (ICT) were consecutively investigated. All patients were registered at the Thalassemia Comprehensive Center affiliated with Shiraz University of Medical Sciences, Shiraz, Southern Iran. Complete ophthalmic examination was performed by an expert ophthalmologist. Clinical and hematologic parameters were collected from the patients´ medical records. Results The mean age ± standard deviation (SD) of the patients was 28.4 ± 5.6 years (range: 18–43). Twenty-four patients (30.4%) were male and 29 (36.7%) were splenectomized. The mean ± SD of the best-corrected visual acuity (VA) was 0.960 ± 0.086 decimal, (range: 0.6–1), 0.016 ± 0.046 logMar, (range: 0–0.2). The frequency of patients with VA > 0.1 logMar was 3 (3.8%). The mean intraocular pressure (IOP) was 14.88 ± 3.34 (6–25) mmHg. Fundus abnormalities were observed in 8 patients (10.1%), consisting of increased cup-disk ratio (3.8%), vessel tortuosity (2.5%), retinal pigment epithelium degeneration (2.5%), myelinated nerve fiber layer (1.3%), and internal limiting membrane wrinkling (1.3%). No significant association was observed between fundus abnormalities, VA, or IOP with hematologic parameters (P > 0.05). TDT patients with diabetes mellitus had significantly higher IOP (P = 0.010) but similar frequency of fundus abnormalities with non-diabetic patients (P > 0.05). Conclusions The frequency of ocular abnormalities in our patients was lower than the previous reports. The frequency of fundus abnormalities were similar in diabetic and non-diabetic thalassemia patients indicating close monitoring and proper management of the disease and comorbidities in these patients.

The Cross-Sectional Case-Control Integrated Analysis of Vitreous Chamber Length, Corneal Volume, and Globe Biometry in Pediatric Beta-Thalassemia Major

“…[16][17][18][19] Despite being reported to be within normal ranges in some studies, IOP in β-TM patients has been shown to be higher than in healthy individuals. 6,20,21 This is consistent with the current study, which found the same IOP trend between β-TM patients and healthy individuals, with a statistically significant difference. This condition, as previously proposed, appears to be secondary to accumulation of iron in the trabecular meshwork.…”

Optical coherence tomography findings in patients with transfusion-dependent β-thalassemia

“…Exclusion criteria were coexistence of other hemoglobinopathies or other types of anemias, those with any congenital ocular abnormality, history of ocular trauma and surgery, glaucoma, high refractive errors (spherical equivalent > 6.00 diopters), retinal disorders including papilledema, papillitis, retinal vascular disorders, and retinal detachment and having no willingness to participate in the study. Recently, we presented clinical ocular findings in 79 TDT patients [ 10 ], accordingly, the patients who cooperated for more investigations by OCT have been discussed in the present study. Twenty-seven age-and sex-matched healthy individuals were selected as controls.…”

“…A complete ophthalmic examination was done for all patients by an expert ophthalmologist. Snellen VA assessment and intraocular pressure (IOP) measurements were conducted for all patients and controls [ 10 ]. Multicolor fundus imaging, OCT of peripapillary RNFL and macular thickness map, and blue light autofluorescence (BAF) imaging were performed for all patients and controls as well.…”

Visual and Auditory Complications during Deferasirox Therapy in Beta-thalassemia

“…Despite high prevalence of deferasirox consumption and numerous studies accessible in the literature, the true scenarios of visual and auditory complications in beta-thalassemia remain fairly inaccurate. In addition, the findings are markedly heterogeneous and inconsistent, with prevalence rates ranging from no visual and auditory disorders to visual and hearing impairment in patients (6,(8)(9)(10). The present study aimed to monitor visual complications such as color blindness, visual acuity change, cataracts, glaucoma, and retinal disorders, as well as auditory complications such as sensorineural hearing loss, tinnitus, and deafness which are the results of deferasirox consumption.…”

“…Among the less studied complications are ophthalmic disorders. Several case reports reported an association between the onset of chelation therapy and occurrence of ocular symptoms (7)(8)(9). Also, auditory disorders occur during treatment with these agents for an extended period at high doses and in patients with augmented ferritin levels (7,10,11).…”